Medicare vs. Medicaid: Which Program Covers What

The Basic Difference Between Medicare and Medicaid

Medicare is a federal health insurance program for people age 65 and older, regardless of income. Some younger people with disabilities or end-stage renal disease also may have access to. You pay into Medicare through payroll taxes during your working years, and it becomes your insurance when you turn 65.

Medicaid is a joint federal and state program that covers low-income individuals and families of any age. Each state runs its own Medicaid program within federal guidelines, so what Medicaid covers and who qualifies varies significantly by state. You do not pay into Medicaid through taxes — it is funded by general tax revenue.

The clearest way to think about it: Medicare is based on age or disability status. Medicaid is based on income. You can have both programs at the same time — this is called being "dual may be able to access."

Key Takeaways

Medicare covers people 65 and older, some younger people with disabilities, and people with end-stage renal disease, regardless of how much money they have.
Medicaid covers low-income people of any age, but income limits and covered services differ from state to state.
You can be enrolled in both Medicare and Medicaid at the same time if you meet the requirements for each program.
Medicare has the same rules nationwide, while Medicaid rules change depending on which state you live in.
Most seniors pay Medicare premiums and cost-sharing; Medicaid typically has no or very low premiums for those who may have access to.

Who Medicare Covers

You become may be able to access for Medicare automatically when you turn 65, as long as you or your spouse worked and paid Medicare taxes for at least 10 years. If you did not work long enough, you can still buy Medicare coverage at age 65, though the premiums will be higher.

People under 65 can also get Medicare if they have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease or amyotrophic lateral sclerosis (ALS). Your age or income does not matter for these groups — only your disability or medical status.

Medicare does not check your bank account or income. A millionaire and someone living in poverty can both have Medicare if they meet the age or disability requirement.

Who Medicaid Covers

Medicaid covers people with low income, but the exact income limit depends on your state and your family situation. In most states, a single adult can earn roughly $1,400 to $2,000 per month and still may have access to, though this varies. Some states are more generous; others are stricter.

Medicaid also covers certain groups regardless of income in some cases: pregnant women, children under 19, parents of dependent children, and people over 65 with very limited resources. Again, the exact rules depend on your state.

Because each state designs its own Medicaid program, two people with identical income and family size might may have access to in one state and not in another. When you move to a new state, your Medicaid status may change. You can find your state's specific rules through your state Medicaid office or by calling 211.

What Medicare Covers

Medicare has four parts. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Most people pay a monthly premium for Part B.

Part D is prescription drug coverage, offered by private insurance companies approved by Medicare. You choose a Part D plan during enrollment periods, and the premium and coverage vary by plan. Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Private insurers offer Part C plans that bundle hospital and doctor coverage, often with prescription drug coverage included.

Medicare does not cover dental, vision, hearing aids, or long-term care (nursing home or assisted living). It also does not cover all prescription drugs — only those on your chosen Part D plan's formulary. You pay cost-sharing: deductibles, copayments, and coinsurance.

What Medicaid Covers

Medicaid must cover certain services in every state: hospital care, doctor visits, emergency services, lab work, X-rays, and family planning. But each state can add extra coverage on top of these basics.

Many states cover dental care, vision care, hearing aids, and prescription drugs through Medicaid — but not all. Some states cover long-term care (nursing home or assisted living) for people who may have access to financially; others do not. Some cover mental health and substance use treatment extensively; others offer minimal coverage.

Because Medicaid varies so much by state, you need to check what your specific state Medicaid program covers. Your state Medicaid office, 211, or a local Area Agency on Aging can tell you what is available where you live.

Cost Differences: Premiums, Deductibles, and Copayments

Medicare requires most people to pay a monthly premium for Part B (currently around $165 per month, though this changes yearly). You also pay an annual deductible before Medicare starts paying, and then you pay copayments or coinsurance for each service. These costs add up, especially if you use many services or take many medications.

Medicaid typically has no monthly premium or a very small one for people who may have access to. Many states have no copayments for Medicaid services, though some charge small amounts. If you are dual may be able to access — on both Medicare and Medicaid — Medicaid often pays your Medicare premiums and cost-sharing, which can save you hundreds of dollars per year.

If you have limited income and are on Medicare, you may may have access to for a Medicare Savings Program through your state Medicaid office. This program pays some or all of your Medicare premiums and cost-sharing. Ask your state Medicaid office or call 211 to learn if you may have access to.

When You Might Have Both Medicare and Medicaid

You can be enrolled in both programs if you meet the requirements for each. This usually happens when you are 65 or older (or disabled and on Medicare) and have low enough income to may have access to for Medicaid in your state.

Being dual may be able to access is often a financial advantage. Medicaid can cover services Medicare does not, like dental and vision care. Medicaid can also pay your Medicare premiums and out-of-pocket costs, reducing what you pay each month. If you think you might may have access to for Medicaid while on Medicare, contact your state Medicaid office or call 211 to ask about income limits in your area.

How to Find Out Which Program Covers You

If you are 65 or older, you are almost certainly may be able to access for Medicare. You enroll during your Initial Enrollment Period, which starts three months before the month you turn 65 and ends three months after. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or at your local Social Security office.

To learn about you may have access to for Medicaid, contact your state Medicaid office directly — the phone number and website are on your state's health department website. You can also call 211 (dial 2-1-1 from any phone) and they will connect you to your state Medicaid office or a local organization that can help you understand your options.

If you are already on Medicare and think your income has dropped enough to may have access to for Medicaid, do not wait. explore to your state Medicaid office as soon as possible. Medicaid coverage can start as early as the first day of the month you explore, so explore sooner means you get covered sooner.

Frequently Asked Questions

Can I have Medicare and Medicaid at the same time?

Yes. If you are 65 or older (or disabled and on Medicare) and your income is low enough to may have access to for Medicaid in your state, you can have both. Medicaid will often pay your Medicare premiums and cost-sharing, which saves you money each month.

Do I have to pay for Medicare?

Most people pay a monthly premium for Medicare Part B (around $165 per month as of 2024, though this changes yearly). You also pay deductibles and copayments when you use services. If your income is very low, you may may have access to for a Medicare Savings Program that pays some or all of these costs.

What if I move to a different state?

Medicare coverage stays the same no matter where you live — the rules are the same nationwide. Medicaid coverage may change because each state has different income limits and covered services. Contact your new state's Medicaid office to learn about you still may have access to and what services are covered.

How do I know if I may have access to for Medicaid?

Income limits vary by state and family size. Call your state Medicaid office or dial 211 to find out the exact limit where you live and whether you may have access to. You can also explore directly to your state Medicaid office — if you do not may have access to, they will tell you why.

Does Medicare cover dental and vision care?

Original Medicare does not cover routine dental, vision, or hearing services. Some Medicare Advantage plans (Part C) include dental or vision coverage, but you have to choose a plan that offers it. Medicaid covers these services in some states but not others — check with your state Medicaid office.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.